Elevation in High-Sensitivity Troponin T in Heart Failure and Preserved Ejection Fraction and Influence of Treatment With the Angiotensin Receptor Neprilysin Inhibitor LCZ696
Elevation in High-Sensitivity Troponin T in Heart Failure and Preserved Ejection Fraction and Influence of Treatment With the Angiotensin Receptor Neprilysin Inhibitor LCZ696
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DOI：
10.1161/circheartfailure.114.001427
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发表时间：
2014-11-01
影响因子：
9.7
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
--
作者：
Jhund, Pardeep S.;Claggett, Brian L.;Solomon, Scott D.
背景-高敏肌钙蛋白升高与射血分数降低的稳定性心力衰竭患者的疾病严重程度增加相关，但对于射血分数保留的心力衰竭患者的相关性知之甚少。方法和结果-我们检查了 298 名射血分数保留的心力衰竭患者中高敏肌钙蛋白 T (hs-TnT) 升高的患病率，这些患者参加了血管紧张素受体脑啡肽酶抑制剂与血管紧张素受体的前瞻性比较射血分数保留的心力衰竭管理 (PARAMOUNT) 试验中的阻滞剂，其中血管紧张素受体脑啡肽酶抑制剂 LCZ696 与缬沙坦相比，可降低心力衰竭严重程度的标志物。我们评估了 hs-TnT 与心脏结构和功能之间的关联，以及 36 周内 LCZ696 与缬沙坦相比对 hs-TnT 的影响。 55%的患者在心肌损伤范围内发现hs-TnT升高（>0.014μg/L），并且与年龄较大、糖尿病史、N末端脑钠肽前体较高、估计肾小球滤过率较低以及左心房尺寸、左心室体积和质量较大有关。与缬沙坦相比，LCZ696 治疗在第 12 周（降低 12%；P=0.05）和第 36 周（降低 14%；P=0.03）更大程度地降低了 hs-TnT。结论——在射血分数保留的心力衰竭临床试验中入组的大量患者中，肌钙蛋白 T 升高，并且与心脏结构、功能异常和基线 N 端脑钠尿前体升高相关肽。 LCZ696 降低 hs-TnT，同时改善 N 端脑钠肽前体和左心房大小，表明血管紧张素受体脑啡肽酶抑制剂 LCZ696 可能会减少心力衰竭中心肌损伤的这一指标，同时保留射血分数。
Background-Elevated high-sensitivity troponin is associated with increasing disease severity in patients with stable heart failure with reduced ejection fraction, but less is known about the association in heart failure with preserved ejection fraction.Methods and Results-We examined the prevalence of elevated high-sensitivity troponin T (hs-TnT) in 298 patients with heart failure with preserved ejection fraction enrolled in the Prospective comparison of angiotensin receptor neprilysin inhibitor with angiotensin receptor blocker on Management Of heart failUre with preserved ejectioN fracTion (PARAMOUNT) trial, in which the angiotensin receptor neprilysin inhibitor LCZ696 reduced markers of heart failure severity compared with valsartan. We assessed the association between hs-TnT and cardiac structure and function, and the effect of LCZ696, compared with valsartan, on hs-TnT over 36 weeks. Elevated hs-TnT in the myocardial injury range (>0.014 mu g/L) was found in 55% of patients and was associated with older age, history of diabetes mellitus, higher N-terminal pro-brain natriuretic peptide, lower estimated glomerular filtration rate, and larger left atrial size, left ventricular volume, and mass. LCZ696 treatment reduced hs-TnT to a greater extent at 12 weeks (12% reduction; P=0.05) and at 36 weeks (14% reduction; P=0.03) compared with valsartan.Conclusions-Troponin T was elevated in a substantial number of patients enrolled in a heart failure with preserved ejection fraction clinical trial and was associated with abnormalities of cardiac structure, function, and elevated baseline N-terminal pro-brain natriuretic peptide. Decreases in hs-TnT with LCZ696 in parallel with improvement in N-terminal pro-brain natriuretic peptide and left atrial size suggest that the angiotensin receptor neprilysin inhibitor LCZ696 may reduce this measure of myocardial injury in heart failure with preserved ejection fraction.